IE Flashcards
“typical MOs” for IE
Viridans streptococci
Streptococcus gallolyticus (formerly S. bovis)
HACEK group: Haemophilus spp, Aggregatibacter (formerly Actinobacillus actinomycete comitants), Cardiobacterium hominis, Eikenella spp, and Kingella kingae
Staphylococcus aureus
Community-acquired enterococci, in the absence of a primary focus;
Single positive blood culture for Coxiella burnetii or antiphase I IgG antibody titer >1:800*
what is the special protein that some staph aureus have that makes them particularly good at causing IE?
it is the fibronectin binding protein
what is the most common cause of early prosthetic valve (<2 months) IE?
40% are culture neg
20% ENT source
17% coag neg staph
what is the most common cause of prosthetic valve IE (2 - 12 months after surgery)?
27% are coag neg staph
13% culture neg
7% is staph aureus
what is the most common cause of late prosthetic valve IE? (>12 months)
staph aureus makes up 25%
20% enterococcus
12% culture neg
9% coag neg staph
mitral is more common than aortic
what is the greatest risk factor for IE?
previous IE is the strongest
relapse is when it is the same MO within 6/12
reinfection is different bug > 6/12
what is the most common cause of pacemaker associated ie?
coag neg staph is 54%
staph aureus is 23%
if you think someone has brucella infective endocarditis, and blood cultures have failed to become positive, what is the next test?
you can do serology
or you could do a bone marrow
what has a worse prognosis: early or late prosthetic valve endocarditis?
early has a 33-100% mortality
late 25-50% mortality
what are the risk factors for death (from IE)?
age staph aureus CVA and embolic events heart failure health care associated IE
what are the recommended empiric treatment for native valve IE?
acute presentation:
vanc plus gent
indolent:
amoxicillin plus gent
if pen allergy - vancomycin
what is the empiric treatment for prosthetic valve IE?
if early (12 months): as per native valves -- vanc plus gent or amoxi plus gent
which of the strep are associated with invasion and abscesses?
Strep Anginosus (milleri)
which of the strep is most likely to have the immunoloigically mediated signs?
strep viridans (sanguis and mutans)
which population is Group B strep IE associated with?
preggos
immunosuppressed
alcoholics
these ones need surgery for cure
what are the indications for urgent surgery in IE?
what about semi-urgent?
if heart failure due to IE, this is URGENT, esp if cardiogenic shock or refractory pulm oedema
semi-urgent:
uncontrolled infection - particularly fungal, s. aureus and s. lugdunenensis, group B strep
prevention of embolism
early PVE > late PVE
what is the most common site, and most common bug for IE in IVDU?
tricuspid and s. aureus
usually only 1 in 3 have signs though
but might be symptomatic with fever, chills and pleuritic chest pain
what is the most common cause of culture neg endocarditis?
apparently it is antibiotics being given prior to BCs
what are the recommended pre-procedure antibiotic prophylaxis for dental procedures?
what about GIT/GUT procedures?
for dental it is:
amoxil 2g oral 1 hour prior
if pen allergy, clinda or cephalex orally 1 hour prior
for GIT/GUT where the mucosa might be crossed for biopsies, we need to cover enterococci:
IV amoxil 2g 30 minutes prior
if pen allergy:
vanco 1g given 30 min prior
or teicoplanin just before
which of the congenital heart defects should have prophylaxis?
- VSD
- MVP
- tetralogy of Fallot
- asd
it’s only cyanotic heart disease
apparently even a VSD doesn’t get prophylaxis with a dental procedure these days
however, if the tooth is infected, then they should have antibiotics for the tooth infection
what sorts of people get antibiotic prophylaxis in Australia?
any one with prosthetic material
anyone with cyanotic heart disease
